Complementary role of transoesophageal echocardiography to coronary angiography in the assessment of coronary artery anomalies.

OBJECTIVE: To examine the role of transoesophageal echocardiography in the assessment of patients with coronary artery anomalies.

BACKGROUND: Coronary artery anomalies are difficult to detect clinically. Most are benign but some may produce symptoms that can be life threatening. Until recently the non-invasive assessment of coronary artery anomalies has been limited.

METHODS: The data base of transoesophageal echocardiographic studies performed between September 1988 and April 1991 were reviewed to identify all cases of coronary artery anomalies. There were six patients with such anomalies who had also had coronary angiography. The findings of these two imaging techniques were analysed to determine whether transoesophageal echocardiography added useful data in these cases.

RESULTS: Of the six patients, the coronary anomaly was discovered during angiography in four patients, during a transthoracic echocardiographic study in one patient, and as an incidental finding in the other patient. Aberrant origins of the left coronary artery were detected in two patients, and coronary artery fistulae were present in the other four. Transoesophageal echocardiography provided unique information on the course of an aberrant left coronary artery in one patient and the precise location of drainage sites of coronary artery fistulas in three patients.

CONCLUSION: Transoesophageal echocardiography was complementary to angiography in the assessment of coronary artery anomalies. It can locate and delineate the course of an ectopic coronary artery and the drainage site of a coronary fistula. These anatomical data can be crucial to the management of these patients.